Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis

Kang

et al. 2019

Sci Rep

Early diagnosis and proper treatment of pyogenic vertebral osteomyelitis (PVO) in patients with cirrhosis is challenging to clinicians, and the mortality rate is expected to be high. A retrospective study was conducted to investigate the treatment outcome in PVO patients with cirrhosis and to identify the predictors of their mortality. Mortality was divided into two categories, 30-day and 90-day mortality. A stepwise multivariate logistic regression model was used to identify predictors of mortality. Eighty-five patients were identified after initial exclusion. The patients’ mean age was 60.5 years, and 50 patients were male. The early mortality rates within 30 and 90 days were 17.6% and 36.5%, respectively. Multivariate analysis revealed that increased age, CTP class C, and bacteremia at the time of PVO diagnosis were predictors of 30-day mortality, while higher MELD score, presence of combined infection, and multiple spinal lesions were predictors of 90-day mortality. Attention should be paid to the high mortality between 30 and 90 days after PVO diagnosis (18.8%), which was higher than the 30-day mortality. Liver function was consistently a strong predictor of mortality in PVO patients with cirrhosis. The high-risk patients should be targeted for an aggressive diagnostic approach, using spinal MRI and intensive monitoring and treatment strategies.

Section: Discussionmentioning

confidence: 99%

Treatment outcomes in patients with pyogenic vertebral osteomyelitis who have cirrhosis

Kang

et al. 2019

Sci Rep

“…Clinically, it is characterized by a spectrum of symptoms, including cognition impairment, altered levels of consciousness that may progress to coma and death[2]. The risk of mortality has usually been related to higher grades of HE, and the incidence of this disease is increased in patients with frequent infections[3,4]. Patients with HE are greatly impacted in terms of quality of life and the high costs caused by increased healthcare utilization[5,6].…”

Section: Introductionmentioning

confidence: 99%

Hepatic encephalopathy: Lessons from preclinical studies

Lima

Miranda

Ferreira

et al. 2019

WJH

Hepatic encephalopathy (HE) is a major complication that is closely related to the progression of end-stage liver disease. Metabolic changes in advanced liver failure can promote cognition impairment, attention deficits and motor dysfunction that may result in coma and death. HE can be subdivided according to the type of hepatic injury, namely, type A, which results from acute liver failure, type B, which is associated with a portosystemic shunting without intrinsic liver disease, and type C, which is due to chronic liver disease. Several studies have investigated the pathogenesis of the disease, and most of the mechanisms have been explored using animal models. This article aimed to review the use of preclinical models to investigate HE. The most used animal species are rats and mice. Experimental models of type A HE include surgical procedures and the administration of hepatotoxic medications, whereas models of types B and C HE are generally surgically induced lesions in liver tissue, which evolve to hepatic cirrhosis. Preclinical models have allowed the comprehension of the pathways related to HE.

“…Repeated episodes of more than three infections per year can increase the risk for the development of HE by 10‐fold. The infections that are most likely to cause HE are SBP, biliary tract infection, and sepsis . Of course, the presence of other organ failures with the infective episode can also exacerbate HE.…”

Section: Individual Organ Failuresmentioning

confidence: 99%

Clinical Consequences of Infection in Cirrhosis: Organ Failures and Acute‐on‐Chronic Liver Failure

Wong

2019

Clinical Liver Disease